It's Joint Not Muscle !
Pain from Temporomandibular disorders can be either articular or muscular in origin, or both. Distinguishing the precise source of the pain is an important diagnostic challenge to clinicians, because effective TMD management relies on establishing a correct diagnosis.
According to literature; clinical signs and symptoms from TMJs to support the presence of inflamed hyperplastic retrodiscal tissue couldn’t be discovered. The aim of this study is to present a reliable precise clinical diagnostic sign for articular joint pain due to disc displacement and subsequent compression of inflamed retrodiscal tissue and/or nerve entrapment phenomenon and support it with arthroscopic findings of retrodiscal tissue inflammation.
Material and Methods:
298 patients with 415 joints suffering from synovial TMJ disease with different etiological types and diagnostic categories were retrospectively analyzed. All patients were subjected to preoperative routine TMJ clinical assessment including as well examination of a joint loading (JL) pain sign. Patients then underwent a diagnostic and operative arthroscopy. The date of study was from July 2007 to August 2012. All cases were done in Baptist hospital, Miami, Florida, USA. Arthroscopic findings regarding disc position and retrodiscal tissue synovitis were recorded for statistical correlation. Chi square test was used to study the relations between the variables. Methods of data analysis:
Sample size: 298 patients with 415 joints
Duration of the study: from July 2007 to August 2012
Statistical methods: Chi square test
Retrospective subjective analysis study.
Results of investigation:
In synovitis free patients, JL sign was positive in 14 joints (11%) and it was negative in 113 joints (89%). On the other hand JL sign in patients with synovitis, was positive in 215 joints (74.7%) and it was negative in 73 joints (25.3%). Chi square test showed a significant relation between synovitis and JL (p=0.001) i.e. a significant percentage of synovitis free patients had a negative JL sign (SRV=7.4). Similarly a significant percentage of patients with synovitis have a positive JL sign (SRV=4.4).
The relation between synovitis, JL and Wilkes classification in synovitis free patients was proved to be statistically significant by chi square test p=0.033. The highest percentage of synovitis free patients with negative JL were: Wilkes V (33.9%) followed by Wilkes II patients (22%). On the other hand 24.3% of patients with synovitis and positive JL sign were Wilkes III followed by 22.2% Wilkes IV. Chi square test showed a significant relation in this group of patients. P=0.41 Conclusions:
The clinical test of joint loading is for the most part an accurate sign of retrodiscal synovitis. The negative joint loading sign in wilkes V is explained by the fact that the condyle goes through perforation and doesn’t load the retrodiscal tissue. Conversely a positive sign is seen frequently in wilkes III, IV. In wilkes II the sign is positive contingent on retrodiscal inflammation so in conclusion if the JL Pain Sign is positive it’s joint not muscle!
Refrences:
1. Isberg A, Isacsson G, Johansson AS, Larson O. Hyperplastic soft-tissue formation in the temporomandibular joint associated with internal derangement. A radiographic and histologic study.
Oral Surg Oral Med Oral Pathol. 1986 Jan; 61(1): 32-8.
2. Johansson AS, Isberg A, Isacsson G. A radiographic and histologic study of the topographic relations in the temporomandibular joint region: implications for a nerve entrapment mechanism. J Oral Maxillofac Surg. 1990 Sep; 48(9): 953-61; discussion 962.